To investigate the clinical features, imaging features, pathological manifestations, treatment and prognosis of solitary fibrous tumors (SFT) originate in nasal cavity and paranasal sinus, and to further clarify the diagnostic points of SFT, the clinical data of 4 patients with SFT in the nasal cavity and paranasal sinus from our hospital were analyzed. The histological and immunophenotypic features of these tumors were observed and the related literatures were reviewed. Pathological examination of the specimens of four patients after endoscopic sinus surgery showed that under the microscope, tumors were submucosal and pseudoencapsulated. Bland plump spindle cells dispersed within a collagenous stroma, haphazard arrangement, hypercellular and hypocellular sclerotic foci. There was a prominent branching vasculature around the tumor cells arranged as hemangiopericytoma-like. Tumor cells had scant eosinophilic cytoplasm, ovoid nuclei with fine chromatin, and inconspicuous nucleoli. Immunohistochemically, tumors were diffuse positive for STAT6 (nuclear) and CD34, also positive for BCL2 and CD99, but non-reactive with desmin, S100, EMA and CK. The proliferation index of Ki-67 was about 1–5%. SFT in nasal cavity and paranasal sinus is a kind of borderline/low-grade malignant soft tissue tumor, which is extremely rare. About 5% to 10% of all SFTs have shown recurrence. Therefore, the prognosis may be closely related to the completeness of the surgical resection.